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I now have sufficient information from authoritative textbooks to create 15 high-quality MCQs covering all aspects of glaucoma. Here they are:

🔵 MCQs on Glaucoma — MBBS Level (15 Questions)

Section A: Anatomy & Pathophysiology

Q1. Aqueous humor is produced by which structure?

A) Corneal endothelium
B) Non-pigmented ciliary epithelium of the pars plicata
C) Trabecular meshwork
D) Canal of Schlemm

✅ Answer: B Explanation: Aqueous humor is produced by the non-pigmented ciliary epithelium of the pars plicata of the ciliary body. It drains through the trabecular meshwork and uveoscleral pathways. (Goldman-Cecil Medicine)

Q2. The primary route of aqueous humor drainage is through:

A) Uveoscleral pathway
B) Iris surface
C) Trabecular meshwork into Schlemm's canal
D) Vitreous humor

✅ Answer: C Explanation: Most aqueous humor drains through the trabecular meshwork situated in the iridocorneal angle into the Schlemm's canal. The uveoscleral pathway is a minor route. (Robbins Pathologic Basis of Disease)

Q3. The primary site of damage to the optic nerve in glaucoma is:

A) Optic chiasm
B) Macula
C) Lamina cribrosa
D) Lateral geniculate body

✅ Answer: C Explanation: The primary site of glaucomatous optic nerve damage is at the lamina cribrosa, where the axons of the optic nerve exit the eye. (Goldman-Cecil Medicine)

Q4. In angle-closure glaucoma, which mechanism leads to elevated IOP?

A) Increased aqueous production by ciliary body
B) Iris apposition to trabecular meshwork blocking aqueous outflow
C) Reduced uveoscleral drainage
D) Blockage of Schlemm's canal by fibrillar deposits

✅ Answer: B Explanation: In angle-closure glaucoma, the peripheral iris adheres to the trabecular meshwork (forming peripheral anterior synechiae), physically blocking aqueous outflow and raising IOP. (Robbins Pathologic Basis of Disease)

Section B: Classification & Clinical Features

Q5. Normal intraocular pressure (IOP) is defined as:

A) < 10 mm Hg
B) 10–15 mm Hg
C) Up to 21 mm Hg
D) Up to 30 mm Hg

✅ Answer: C Explanation: Ocular hypertension is defined as IOP > 21 mm Hg (>2 SD above the population mean). However, glaucoma can occur even at normal pressures (normal-tension glaucoma). (Goldman-Cecil Medicine)

Q6. The most common type of glaucoma is:

A) Acute angle-closure glaucoma
B) Congenital glaucoma
C) Primary open-angle glaucoma
D) Secondary glaucoma due to uveitis

✅ Answer: C Explanation: Primary open-angle glaucoma (POAG) is the most common type, particularly in the elderly. In POAG, the trabecular meshwork is anatomically accessible, but resistance to outflow is increased. (Goldman-Cecil Medicine)

Q7. Which of the following is NOT a recognized risk factor for glaucoma?

A) African ancestry
B) Hyperopia
C) Family history
D) Low blood pressure

✅ Answer: B Explanation: Risk factors include African ancestry, older age, myopia (not hyperopia), low blood pressure, genetic predisposition, and disc haemorrhage. Hyperopia is a risk for angle-closure, not open-angle glaucoma specifically. (Goldman-Cecil Medicine)

Q8. A patient presents with acute severe eye pain, nausea, vomiting, redness, and a fixed mid-dilated pupil. The most likely diagnosis is:

A) Acute iritis
B) Corneal ulcer
C) Acute angle-closure glaucoma
D) Central retinal artery occlusion

✅ Answer: C Explanation: Classic presentation of acute angle-closure glaucoma: prostrating eye pain, headache, nausea/vomiting, red eye, and a fixed, moderately dilated pupil. (Harrison's Principles of Internal Medicine)

Q9. In glaucoma, the characteristic finding on optic disc examination is:

A) Disc pallor with no cupping
B) Increased cup-to-disc ratio
C) Papilloedema
D) Cherry-red spot at the disc

✅ Answer: B Explanation: Loss of retinal ganglion cell axons leads to enlargement of the optic cup, recorded as an increased cup-to-disc ratio. A C:D ratio >0.6 is suspicious. (Goldman-Cecil Medicine)

Q10. Visual field defects in primary open-angle glaucoma typically begin in which area?

A) Central vision (macular area)
B) Temporal peripheral field
C) Nasal peripheral and paracentral areas
D) Superior temporal quadrant only

✅ Answer: C Explanation: Glaucomatous field loss begins in the nasal peripheral and paracentral regions (arcuate scotomas, nasal step). Central (macular) vision is typically preserved until late stages. (Kanski's Clinical Ophthalmology)

Section C: Pharmacology / Drug Treatment

Q11. The first-line topical drug class for primary open-angle glaucoma is:

A) Carbonic anhydrase inhibitors
B) Prostaglandin analogues
C) Alpha-2 agonists
D) Cholinergic agonists

✅ Answer: B Explanation: Prostaglandin analogues (e.g., latanoprost 0.005%, travoprost 0.004%) are the most commonly used first-line agents. They are given once daily and work by increasing uveoscleral outflow. (Goldman-Cecil Medicine; Katzung's Pharmacology)

Q12. Timolol eye drops lower IOP by:

A) Increasing trabecular outflow
B) Decreasing aqueous humor secretion
C) Increasing uveoscleral drainage
D) Constricting the pupil to open the angle

✅ Answer: B Explanation: Timolol is a beta-adrenergic blocker that lowers IOP by decreasing aqueous humor secretion by the ciliary body. It lacks local anesthetic properties and is well-suited for topical use. (Katzung's Pharmacology; Ganong's Physiology)

Q13. A known asthmatic patient is diagnosed with glaucoma. Which drug is CONTRAINDICATED?

A) Latanoprost
B) Timolol
C) Dorzolamide
D) Brimonidine

✅ Answer: B Explanation: Timolol (and other topical beta-blockers) are contraindicated in asthma and COPD due to risk of bronchospasm from systemic absorption. Prostaglandins and carbonic anhydrase inhibitors are safer alternatives. (Textbook of Family Medicine; Wills Eye Manual)

Q14. Which of the following is a known adverse effect of prostaglandin analogues (e.g., latanoprost)?

A) Increased aqueous secretion
B) Irreversible brown pigmentation of the iris
C) Corneal oedema
D) Acute angle closure

✅ Answer: B Explanation: Prostaglandin analogues cause irreversible brown iris pigmentation, eyelash lengthening/darkening, drying of eyes, and conjunctivitis as notable adverse effects. (Katzung's Pharmacology)

Section D: Surgical Management

Q15. The standard surgical procedure for glaucoma that creates a fistula between the anterior chamber and episcleral tissue is:

A) Trabeculotomy
B) Trabeculectomy
C) Goniotomy
D) Cyclophotocoagulation

✅ Answer: B Explanation: Trabeculectomy (filtering surgery) creates a fistula bypassing the trabecular meshwork to allow aqueous drainage into the episcleral/subconjunctival space. It is used in resistant cases. Tube-shunts are an alternative for refractory cases. (Goldman-Cecil Medicine)

📊 Summary Table

#	Topic	Correct Answer
1	Aqueous production site	B
2	Aqueous drainage pathway	C
3	Site of optic nerve damage	C
4	Mechanism in angle-closure	B
5	Normal IOP	C
6	Most common glaucoma	C
7	Risk factors	B
8	Acute angle-closure presentation	C
9	Optic disc finding	B
10	Visual field defects	C
11	First-line drug class	B
12	Timolol mechanism	B
13	Contraindicated drug in asthma	B
14	Prostaglandin adverse effect	B
15	Standard glaucoma surgery	B

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